Montana Administrative Register Notice 37-555 No. 16   08/25/2011    
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In the matter of the amendment of ARM 37.86.2907 pertaining to Medicaid inpatient hospital services






TO:  All Concerned Persons


            1.  On September 14, 2011, at 10:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders Helena, Montana, to consider the proposed amendment of the above-stated rule.


2.  The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice.  If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on September 5, 2011, to advise us of the nature of the accommodation that you need.  Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail dphhslegal@mt.gov.


3.  The rule as proposed to be amended provides as follows, new matter underlined, deleted matter interlined:


37.86.2907  INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, APR-DRG PAYMENT RATE DETERMINATION  (1)  The department's APR-DRG prospective payment rate for inpatient hospital services is based on the classification of inpatient hospital discharges to APR-DRGs.  The procedure for determining the APR-DRG prospective payment rate is as follows:

            (a) and (b) remain the same.

            (c)  The department computes a Montana average base price per case.  This base price includes in-state and out-of-state distinct part rehabilitation units and long term care (LTC) facilities.  Effective August 1, 2011 the average base price, including capital expenses, is $4,000 $4,129.  Disproportionate share payments are not included in this price.

            (i)  The average base price for Center of Excellence hospitals, including capital expenses, is $6,884 $6,890.  Disproportionate share payments are not included in this price.

            (d) through (2) remain the same.


AUTH:  2-4-201, 53-2-201, 53-6-113, MCA

IMP:     2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA


            4.  Statement of Reasonable Necessity


The Department of Public Health and Human Services (the department) is proposing an amendment to ARM 37.86.2907 regarding Medicaid inpatient hospital services.


The purpose of the proposed rule amendment is to correct the base rates regarding Medicaid inpatient hospital services for state fiscal year (SFY) 2012 that were incorrectly reported in MAR Notice 37-545.


Because the base rates for SFY 2012 were incorrectly reported in MAR Notice 37-545, this proposed amendment to ARM 37.86.2907 will reflect the correct base rates for Medicaid inpatient hospital services.  The correct rates are $4,129 for the Montana average base rate and $6,890 for the base rate pertaining to Centers of Excellence.  The department intends to apply the amendments on August 1, 2011, for that reason, these rates will be retroactively effective from that date.


During the public hearing pertaining to MAR Notice 37-545 on July 15, 2011, testimony was given to providers, interested parties, and the general public regarding the increase in inpatient base rates.  After the 2011 Legislative session was completed, further analysis of the Medicaid budget was done by the department.  This analysis indicates that an increase in inpatient base rates was warranted.  However, since these increased rates were not reported in the adopted rule notice, it is necessary for the department to amend ARM 37.86.2907 to reflect the testimony given to the public and insert the correct rates into the rule.


Fiscal Impact


Because this proposed rule is a correction to ARM 37.86.2907, as published in MAR Notice 37-545, there is no fiscal impact.


            5.  Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to: Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail dphhslegal@mt.gov, and must be received no later than 5:00 p.m., September 22, 2011.


6.  The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.


7.  The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices.  Notices will be sent by e-mail unless a mailing preference is noted in the request.  Such written request may be mailed or delivered to the contact person in 5 above or may be made by completing a request form at any rules hearing held by the department.


8.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.


9.  The bill sponsor contact requirements of 2-4-302, MCA, do not apply.




/s/ John Koch                                               /s/ Laurie G. Lamson for                            

Rule Reviewer                                             Anna Whiting Sorrell, Director

                                                                        Public Health and Human Services


Certified to the Secretary of State August 15, 2011



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